2018 New Mexico Statutes
Chapter 59A - Insurance Code
Article 23B - Minimum Healthcare Protection
Section 59A-23B-6 - Forms and rates; approval of the superintendent; adjusted community rating.
A. All policy or plan forms, including applications, enrollment forms, policies, plans, certificates, evidences of coverage, riders, amendments, endorsements and disclosure forms, shall be submitted to the superintendent for approval prior to use.
B. No policy or plan may be issued in the state unless the rates have first been filed with and approved by the superintendent. This subsection shall not apply to policies or plans subject to the Small Group Rate and Renewability Act [59A-23C-1 NMSA 1978].
C. In determining the initial year's premium or rate charged for coverage under a policy or plan, the only rating factors that may be used are age, gender pursuant to this subsection, geographic area of the place of employment and smoking practices, except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment. In determining the initial and any subsequent year's rate, the difference in rates in any one age group that may be charged on the basis of a person's gender shall not exceed another person's rate in the age group by more than the following percentage of the lower rate for policies issued or delivered in the respective year; provided, however, that gender shall not be used as a rating factor for policies issued or delivered on or after January 1, 2014:
(1) twenty percent for calendar year 2010;
(2) fifteen percent for calendar year 2011;
(3) ten percent for calendar year 2012; and
(4) five percent for calendar year 2013.
D. No person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under the age of nineteen or children aged nineteen to twenty-five who are full-time students may be lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit an insurer, society, organization or plan from offering rates that differ depending upon family composition.
E. The provisions of this section do not preclude an insurer, fraternal benefit society, health maintenance organization or nonprofit healthcare plan from using health status or occupational or industry classification in establishing:
(1) rates for individual policies; or
(2) the amount an employer may be charged for coverage under a group health plan.
F. As used in Subsection E of this section, "health status" does not include genetic information.
G. The superintendent shall adopt regulations to implement the provisions of this section.
History: Laws 1991, ch. 111, § 6; 1994, ch. 60, § 3; 1997, ch. 22, § 2; 1997, ch. 243, § 21; 1998, ch. 41, § 3; 2010, ch. 95, § 3.
The 2010 amendment, effective May 19, 2010, in Subsection C, in the first sentence, after "rating factors used are age, gender", added "pursuant to this subsection" and in the second sentence, after "another person's rate in the age group by more than", deleted "twenty percent of the lower rate, and no person's rate shall exceed the rate of" and added the remainder of the sentence, including Paragraphs (1) through (4); and in Subsection D, in the first sentence , at the beginning of the sentence, added "No person's rate shall exceed the rate of".
The 1998 amendment substituted "superintendent" for "department of insurance" near the end of Subsection A; added Subsection D; and redesignated former Subsection D as Subsection E.
The 1997 amendment, effective April 11, 1997, in Subsection C, deleted "Until July 1, 1998" from the beginning of the first and second sentences, inserted "except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment" at the end of the first sentence, and inserted "or children aged nineteen to twenty-five who are full-time students" following "under the age of nineteen" in the second sentence, deleted former Subsection D relating to charging the same premium for the same coverage regardless of medical risk, job risk, or gender, and redesignated former Subsection E as Subsection D.
The 1994 amendment, effective January 1, 1995, added "adjusted community rating" at the end in the section heading and added Subsections C to E.
